Provider Demographics
NPI:1457432122
Name:RECTOR, ERNEST REGINALD (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:REGINALD
Last Name:RECTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 VALENCIA ST STE 603
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4415
Mailing Address - Country:US
Mailing Address - Phone:415-831-6950
Mailing Address - Fax:415-831-6955
Practice Address - Street 1:1580 VALENCIA ST STE 603
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4415
Practice Address - Country:US
Practice Address - Phone:415-831-6950
Practice Address - Fax:415-831-6955
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84062208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG84062OtherLICENSE
954697520OtherEIN
954697520OtherEIN
CAG70610Medicare UPIN